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Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: a prospective,
Michelle S Chew1, Vibeke Brix-Christensen, Hanne B Ravn
1Department of Anaesthesia and Intensive Care, Institute of Experimental Clinical Research, Aarhus University Hospital, Denmark. mchew@iekf.au.dk
Insights
Modified ultrafiltration (MUF) in pediatric cardiac surgery did not significantly alter inflammatory markers. However, MUF showed a trend towards improved clinical outcomes, suggesting benefits beyond inflammation modulation.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiopulmonary Bypass
- Modified Ultrafiltration
Background:
- Modified ultrafiltration (MUF) is commonly used with pediatric cardiopulmonary bypass (CPB).
- Its benefit may stem from removing inflammatory mediators, but this is unproven.
Purpose of the Study:
- To investigate if MUF improves clinical outcomes by reducing inflammatory mediators in pediatric cardiac surgery.
Main Methods:
- Prospective randomized study of 18 infants (12-24 months) undergoing cardiac surgery with CPB.
- Patients received methylprednisolone and were randomized to CPB with or without MUF.
- Measured cytokines, complement, coagulation markers, and clinical outcomes (oxygenation, drainage, hemodynamics).
Main Results:
- MUF group showed improved postoperative oxygenation and trends towards decreased drain loss and better hemodynamics.
- No significant intergroup differences were found in measured inflammatory markers (TNFalpha, IL-1beta, IL-1ra), complement, or coagulation profiles.
- Clinical outcomes improved in the MUF group despite no significant changes in measured inflammatory mediators.
Conclusions:
- MUF does not significantly impact key inflammatory, complement, or coagulation markers in pediatric cardiac surgery.
- While clinical outcomes showed some improvement with MUF, these benefits are not explained by the measured inflammatory mediator modulation.
Abstract:
Modified ultrafiltration (MUF) is often used in conjunction with paediatric cardiac surgery with cardiopulmonary bypass (CPB) and is thought to improve clinical outcome. It is unclear whether these improvements (if any) are due to the removal of inflammatory mediators. In this prospective study, 18 children aged 12-24 months undergoing uncomplicated cardiac surgery with methylprednisolone added in the pump prime were randomized to receive CPB with (n = 10) and without (n = 8) MUF. Cytokines (TNFalpha, IL-6, IL-1beta, IL-10, IL-1ra), complement split products (C3d, C4d) and coagulation system activation (F1 + 2, ATIII) were measured pre-, peri- and up to 48 h postoperatively. For clinical outcome, the alveolar-arterial oxygen (A-a) gradient, transfusion requirement, drain loss, mean blood pressure and requirement for inotropic support were registered up to 24 h postoperatively. Our results show an improvement in postoperative oxygenation as well as a tendency towards decreased drain loss and improved haemodynamics in the MUF group. There were no intergroup differences detectable for TNFalpha, IL-1beta, IL-1ra, complement and coagulation markers. We conclude that MUF in itself does not significantly influence TNFalpha, IL-1beta, IL-1ra and the complement and coagulation profiles in children undergoing cardiac surgery with CPB. Despite this, there was some evidence for improved clinical outcome. Our results do not support that MUF improves postoperative organ function by modulation of the measured markers of inflammation.